The Imperative for Financial Independence in HIEs

As grant money from the Office of the National Coordinator for Health Information Technology (ONC) and other grantors dries up for Health Information Exchanges (HIEs), solutions are necessary for sustaining these very important entities. Some are flourishing while others are struggling or closing. It has become a paradox as to how and why some HIEs survive while others do not even though all address the same business concerns. Since the early growth and adoption of the HIE, one model that seemingly reflects a cornerstone enabling HIE financial independence: the member fee model.

The member fee model is used where there is a cost for use of HIE-provided services and products. One example of the successful implementation of the member fee model is the Georgia Health Information Network (GaHIN). GaHIN is a non-profit organization dedicated to the use and exchange of electronic health information to foster a healthier Georgia, improve patient centered healthcare, increase efficiency and promote the health status of the entire state population. GaHIN is part of a public-private collaborative of healthcare stakeholders from around the state, including the Georgia Department of Community Health and the Georgia Health Information Technology Extension Center. These organizations and many others work together to establish the statewide HIE technology infrastructure to electronically connect healthcare providers. In other words, GaHIN is a network of networks, providing information sharing among all of its networks (including physician practices, hospitals, clinics, laboratories, and other healthcare facilities) regardless of their different frameworks and infrastructures. These different networks may subscribe to various levels of scalable products and services, each priced seperately. As such, this approach allows for the majority of operating costs to be absorbed by membership subscriptions rather than by the patient provider community.

The Kansas Health Information Network (KHIN) has a similar member subscriber model, offering fee-variable subscriptions to providers of all sizes. Because of its wide range of partnerships, KHIN is able to create built-in mechanisms such as incentives to increase participation and membership.

KHIN’s partnership with Blue Cross/Blue Shield of Kansas (BCBSKS) allows providers to be incentivized (by up to 1.25%) to join the HIE. BCBSKS is required to credential their provider network in order to participate on the HIE as a Qualified Health Plan. The credentialing program is based on the URAC Health Plan Credentialing Standards. BCBSKS has been granted provisional health plan accreditation status, meaning they will be eligible to sell their products on the exchange. Other incentives include 0.5% for hospitals and performance-based incentives for Managed Care Organizations.

While incentives create buy-in and participation, the membership fee itself is an important component of KHIN’s sustainability. Memberships range from $100-$100,000 per month. This is a wide range of pricing, but it is all relative… “As a health information exchange, you have to offer products and services to move forward”, says KHIN Executive Director Dr. Laura McCrary. “…at the Kansas Health Information Network, we have established a data warehouse and population health reporting, all of which add value to the services for providers.” By this time next year, Dr. McCrary anticipates KHIN to be fully sustainable.

There are a number of other HIE sustainability models. Some are heavily reliant on state funding, while others have more unique methods of gaining financial independence, such as from grant funds (such as Maryland’s all-payer rate setting system). However, few have demonstrated the ingenuity of the member fee model used by GaHIN and KHIN. These models have proven to be gradually sustainable while allowing growth in infrastructure, services, and members.

Want to hear more from KHIN’s Dr. McCrary? Come see her at HIMSS15!
HIE Symposium | Sunday April 12 | 2:00-300pm CT | Room S105
Network of Networks: Approaches to Interoperability from Coast to Coast
(Separate registration required)
Breakout Session | Tuesday April 14 | 1:00-2:00pm CT | Room S404
The Portal Balancing Act: Meeting Patient and Provider Needs

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